Provider Demographics
NPI:1356886493
Name:HEALTHY SPINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HEALTHY SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEFANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-370-6256
Mailing Address - Street 1:1301 PRINCE RODGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2020
Mailing Address - Country:US
Mailing Address - Phone:908-370-6256
Mailing Address - Fax:
Practice Address - Street 1:1301 PRINCE RODGERS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2020
Practice Address - Country:US
Practice Address - Phone:908-370-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00582700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty